Table 3.

Feedback loops in the policy model

Name of feedback loop	Feedback loop structure	Explanation of feedback loop	Participant quotations
R9: Punitive policies encourage incarceration and structural stigma		Punitive policies refer to clinic, organizational, community or state policies that criminalize perinatal substance use, classify it as child abuse, or otherwise penalize the birthing person rather than provide necessary supportive services. A punitive policy environment increases the likelihood that a birthing person will be tested for substance use during or after pregnancy. Increased testing and punitive policies drive incarceration of birthing people for SUDs. As incarceration for substance use during pregnancy becomes more common, policymakers may use that as justification for enacting additional punitive policies.	“Mandated toxicology testing for pregnant women and jailing women for substance use contributes to stigma and doesn’t fit with the paradigm of treating substance use disorder as a disease.” – OBGYN Provider
R10: Basic needs must be met to benefit from treatment opportunities		Access to safe and supportive social, physical, and community environments encompasses all social determinants of health that are necessary for an individual to thrive, including access to education, employment, childcare, healthy and affordable food, housing, and other supports. Having these needs met increases a birthing person’s ability to access perinatal and SUD treatment, which lowers the likelihood of incarceration. Alternatively, incarceration takes away a birthing person’s access to a safe, supportive environment and limits their ability to connect to treatment and recovery supports, including medication for opioid use disorder.	“We can’t emphasize enough the importance of comprehensive care, which includes access to healthy food, safe and affordable housing and a safe community in which to raise a family—without these things, it doesn’t matter how great our addiction and pregnancy care is, as we will not be able to meet all of the family’s vital needs.”—Maternal Fetal Medicine and Addiction Medicine Physician